Guest Column
| May 18, 2020

How Hospitals In Contingency Mode Can Leverage Time To Get EHRs Right

By Kristin Stitt, DNP, APRN, TractManager

Time is money" — Benjamin Franklin

The phrase “time is money” is credited to Benjamin Franklin, who used it in a 1748 essay, Advice to a Young Tradesman. These words still ring true, especially in the medical profession where time is money for providers. For forward-thinking hospitals, time is also an opportunity to get things right.

Hospitals across the country that are fortunate enough not to be in crisis mode during the COVID-19 pandemic must alter how they look at time. Rather than focusing on surgeries that have been put on hold, hospitals in contingency mode can use this time to tend to business processes that need improvement. Consider, for example, the challenges of EHRs. Workflow and process issues are common problems when working in an EHR, but corrective processes are routinely placed on the back burner because staff are too busy.

Hospitals invest a significant amount of money in their EHR systems. Today’s EHRs are touted for enabling physicians to deliver higher-quality, safer care to patients. And while EHRs have come a long way, more work remains. For early adopters especially, these issues have proven costly, in terms of both dollars and time spent maneuvering around inefficient systems.

As hospitals wait for cases to resume, those who have the chance to use this time and want to improve their EHR are presented with a unique opportunity. Figuring out where to start can be overwhelming, but for clinicians, an excellent place to begin is a review of mental notes such as, “when I get time to do this, I’m going to…” Taking a tiered approach to addressing EHR issues is most ideal under these unique circumstances.

Start With Providers

Similar to medicine, EHRs require a team effort. Unless administrators are clinical, they won’t know what is needed to improve a workflow. Therefore, it is up to providers (and service line leaders) to communicate what they need in an EHR to be as productive as possible. Is there a certain format or configuration that will improve workflow? Has the coordination of care delivery between the inpatient and the outpatient world been mapped? Have the multiple, disparate processes between ancillary or outreach clinics been considered, with safeguards enlisted to optimize safety?

Once the workflow is defined, providers should consider other ways in which they want the system to be configured. Do they want order sets updated with the latest evidence-based treatments? Who is responsible for reviewing, then handing off to make the appropriate changes, including an effective communication plan? What about the ability to codify elements and standardize a process for specific order sets to ensure outcomes can be captured (an important capability in the move toward value-based reimbursement)? Tracking is another important consideration. Are providers able to easily track results to ensure the Institute for Healthcare Improvements (IHI) guidelines for efficiency, effectiveness, and time windows are followed to demonstrate that the best possible care is delivered? What about the ability to track lab results from a multitude of sources, outcomes, etc.? Don’t forget about automation.

Count the clicks and the alerts. Both are fatiguing, but given sufficient time to address them, the result will be improvements and, hopefully, satisfaction.

Enlist The IT Team

With provider needs defined, it’s up to IT support to operationalize all of these things. During the hand-off, it is critical that providers clearly communicate tracking needs to the IT team. Clinical outcomes are not administrative claims data. It isn’t monitoring claims for re-admissions. Rather, it is the ability to monitor what was done from a care delivery perspective. This is an important distinction that IT will not know unless it’s clearly communicated. At some point, tracking patient-reported outcomes will be attainable. Did the patient feel better after a procedure? Was their state of mind improved? This level of information, and trackability, will play a key role in enabling hospitals to leverage their EHR system for value-based care metrics.

With the ability to standardize formatting within the EHR, providers will gain the capacity to query clinical data for value-based care; this includes tracking patients on a specific outcome. When done correctly it becomes a codified element. Providers can run a report on specific outcomes and track them by patient cohort, gender, geographic location, etc. There are lots of ways to slice and dice data, which truly enhances the value of an EHR as opposed to merely reverting to administrative claims. But if the IT team doesn’t know this need exists, it can’t help.

Leverage The Benefit Of Time

For early adopters, and those who did not get their EHR right the first time around, take this time if you can to make it right, and educate yourself. There are a lot of great add-ons that leverage the data within EHR systems to create even more value and additional efficiencies. Providers and service line leaders need to research what’s available and communicate their needs to IT teams.

Hospitals and health systems that are allowed of time to hone their EHR system have the potential to greatly improve many aspects of care. They will be able to create more efficient processes and workflows, which in turn will allow providers to focus less on technology and more on patients. And, these improvements will ensure that hospitals are well-positioned in the move toward value-based payments.